An analysis of clinical characteristics of rare bilateral medial medullary infarction: An observational study.

This study aimed to characterize the risk factors, etiology, clinical manifestations, anatomical characteristics, stroke mechanisms, imaging features, and prognosis of bilateral medial medullary infarction (BMMI). A retrospective analysis was conducted on 11 patients with BMMI who met the inclusion criteria at the Affiliated Hospital of Xuzhou Medical University from January 2013 to January 2023. The patients' imaging and clinical features were analyzed and summarized. Eleven patients (7 male, 4 female), aged 46 to 62 years, met the inclusion criteria. Common clinical presentations included dysarthria (90.9%), dysphagia (90.9%), quadriplegia (81.8%), and so on. Within 72 hours of onset, 8 cases presented with quadriplegia, 2 cases with hemiplegia, and 1 case without limb paralysis. The main risk factor for BMMI was hypertension, followed by diabetes. "Heart appearance" infarcts occurred in 4 cases (36.4%), while "Y appearance" infarcts occurred in 7 cases (63.6%). Among the patients, 3 had unilateral vertebral artery stenosis or occlusion, 5 had bilateral vertebral artery stenosis or occlusion, 2 had normal vertebral basilar artery, and 1 did not undergo cerebrovascular examination. All patients received standardized treatment for cerebral infarction. The prognosis was poor, with 81.8% of patients having an unfavorable outcome, including 1 death, 9 cases of disability, and only 1 patient achieving self-care ability after recovery. BMMI is more prevalent in males aged 45 to 60 years. The main risk factors are hypertension and diabetes. Atherosclerosis is the primary etiological subtype. The main clinical manifestations are dyskinesia, dizziness, quadriplegia, and dysarthria. The prognosis of BMMI is poor. The specific imaging features of "heart appearance" or "Y appearance" infarcts aid in the diagnosis of BMMI.

Validity and Reliability of Emergency Severity Index and Conventional Three-Tier Triage System in the Emergency Department, Hospital Universiti Sains Malaysia.

BACKGROUND: The study aimed to examine the reliability and validity of the existing three-tier triaging system and a new five-level emergency triaging system, emergency severity index (ESI), in the Emergency Department (ED) of Hospital Universiti Sains Malaysia (HUSM). METHODS: This study was conducted in HUSM's ED over two study periods. In the first three months, 300 patients were triaged under the three-tier triaging system, and, in the subsequent three months, 280 patients were triaged under the ESI. The patients were triaged by junior paramedics and the triage records were retained and later re-triaged by senior paramedics. The inter-rater reliability was evaluated using Cohen's Kappa statistics. The acuity ratings of the junior paramedics were compared with those of the expert panel to determine the sensitivity and specificity of each acuity level for both the ESI and the three-tier triaging system. The over-triage rate, under-triage rate, amount of resources used, admission rate and discharge rate were also determined. RESULTS: The inter-rater agreement for the three-tier triaging system was 0.81 while that of the ESI was 0.75. The ESI had a higher average sensitivity of 74.3% and a specificity of 94.4% while the three-tier system's average sensitivity was 68.5% and its specificity 87.0%. The average under-triage and over-triage rates for the ESI were 10.7% and 6.2%, respectively, which were lower than the three-tier system's average under-triage rate of 13.1% and over-triage rate of 17.1%. The urgency levels of both the ESI and the three-tier system were associated with increased admission rates and resources used in the ED. CONCLUSION: The ESI's inter-rater reliability was comparable to the three-tier triaging system and it demonstrated better validity than the existing three-tier system.

Evaluation of the factors influencing the housing safety awareness of residents in Shanghai.

Shanghai has experienced rapid urbanization and has a serious housing aging problem. The situation of urban housing safety management needs to be strengthened. However, in China, housing safety management (HSM) is just in its beginning stage and it lacks thorough research. Housing safety awareness is one of the most significant aspects of housing safety management. Therefore, in order to investigate the housing safety awareness of Shanghai residents, this paper investigates the safety attitudes of residents living in housing of different ages using consulting questionnaires and Statistical Package for Social Science (SPSS) software. The results show that in Shanghai, the residents lack an understanding of housing management law, policy, and awareness of safety use and have low willingness to buy commercial insurance. Based on these results, the factors that affect the safety awareness of Shanghai residents are summarized as follows: (1) asymmetric information; (2) assessment of the safety status of the premises; and (3) differences in house users.

Cobalt and cobalt oxides N-codoped porous carbon derived from metal-organic framework as bifunctional catalyst for oxygen reduction and oxygen evolution reactions.

Metal-organic framework (MOF)-derived transition metal/metal oxide-carbon hybrids are promising cost-effective electrocatalysts to replace noble metal catalysts for oxygen reduction reaction (ORR) and oxygen evolution reaction (OER). Herein, Co@CoO@Co3O4-N/C was prepared by two-step thermal treatment of Co-MOF ([Co(INA)2]·0.5EtOH) (INA: isonicotinic acid). Firstly, Co-MOF, as precursor, was pyrolyzed at different temperatures in N2 atmosphere to obtain Co-N/C-T (T = 700, 800, 900 °C) materials among which Co-N/C-800 shows remarkably high ORR activity. After oxidation treatment, Co-N/C-800 is transformed into Co@CoO@Co3O4-N/C which exhibits enhanced electrocatalytic activities for both ORR and OER. The as-obtained Co@CoO@Co3O4-N/C has more positive onset potential (-0.136 V vs. Ag/AgCl) and higher limit current density (4.9 mA cm-2) than Co-N/C-800 (-0.143 V vs. Ag/AgCl and 3.9 mA cm-2), as well as better tolerance to methanol and stability (80.0%) than those of Pt/C (63.2%) for ORR. Co@CoO@Co3O4-N/C also displays outstanding OER performances, with lower overpotential (450 mV) than that of Co-N/C-800 (492 mV) at a current density of 10 mA cm-2. The excellent electrochemical performance of Co@CoO@Co3O4-N/C can be ascribed to uniformly dispersed Co-Nx active sites, strong synergistic effects between N-doped carbon support and Co@CoO@Co3O4 as well as ordered mesoporous structure, boosting mass transfer and accelerating electrocatalytic reaction.

Mono-(2-ethylhexyl) phthalate induces injury in human umbilical vein endothelial cells.

Mono-(2-ethylhexyl) phthalate (MEHP), the active metabolite of di-(2-ethylhexyl) phthalate (DEHP), is a widespread environmental contaminant and has been proved to have potential adverse effects on the reproductive system, carcinogenicity, liver, kidney and developmental toxicities. However, the effect of MEHP on vascular system remains unclear. The main purpose of this study was to evaluate the cytotoxic effects of MEHP on human umbilical endothelial cells (HUVEC) and its possible molecular mechanism. HUVEC cells were treated with MEHP (0, 6.25, 12.5, 25,50 and 100 µM), and the cellular apoptosis and mitochondrial membrane potential as well as intracellular reactive oxygen species were determined. In present study, MEHP induced a dose-dependent cell injury in HUVEC cell via an apoptosis pathway as characterized by increased percentage of sub-G1, activation of caspase-3, -8 and -9, and increased ratio of Bax/bcl-2 mRNA and protein expression as well as cytochrome C releasing. In addition, there was obvious oxidative stress, represented by decreased glutathione level, increased malondialdehyde level and superoxide dismutase activity. N-Acetylcysteine, as an antioxidant that is a direct reactive oxygen species scavenger, could effectively block MEHP-induced reactive oxygen species generation, mitochondrial membrane potential loss and cell apoptosis. These data indicated that MEHP induced apoptosis in HUVEC cells through a reactive oxygen species-mediated mitochondria-dependent pathway.

Perinatal exposure to Di-(2-ethylhexyl)-Phthalate leads to cognitive dysfunction and phospho-tau level increase in aged rats.

Di-(2-ethylhexyl)-Phthalate (DEHP) can affect glucose and insulin homeostasis in periphery and lead to insulin resistance, especially exposure of DEHP during critical developmental period. Given the potential relationship between insulin resistance and pathogenesis of Alzheimer's disease (AD) in elderly life, we investigated the relationship between perinatal DEHP exposure and AD pathogenesis. Our results suggested that perinatal exposure to DEHP can affect the expression of insulin and insulin-Akt- GSK-3ß signal pathway in hippocampus. Furthermore, impaired cognitive ability and increased level of phospho-Tau was observed in DEHP-exposed rat offspring (1.25 ± 0.11 vs. 0.47 ± 0.07, P < 0.05). The present study demonstrates that perinatal exposure to DEHP may be a potential risk factor for AD pathogenesis associated with insulin resistance and insulin metabolism disorder in the hippocampus.